1. Social determinants

2. Determinants of health The range of social, economic and environmental factors which determine the health status of individuals or populations (Nutbeam, 1998)

3. Determinants- income and social status social support networks education employment and working conditions physical environments social environments biology and genetic endowment healthy child development health services

4. Social Determinants Economical Political Behavioral

5. Major Determinants – Deodhar & Sathe Health Environment Genetic constitution Nutrition Lifestyle

6. Public Health Agency of Canada ……….. Income and social statusIncomesocial status Social support networks Education and literacy, e.g. health literacyEducationliteracy Employment/Working conditionsEmploymentWorking conditions Social environments Physical environments Personal health practices and coping skillscoping Healthy child developmentchild development Biology and genetic endowmentBiologygenetic endowment Health services Gender Culture

7. Income and Social Status Health status improves at each step up the income and social hierarchy. High income promotes living conditions such as safe housing and ability to buy sufficient good food. The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth.

8. Social Support Networks Support from families, friends and communities is associated with better health. Effective responses to stress and the support of family and friends seem to act as a buffer against health problems.

9. Education Health status improves with each level of education. Education increases opportunities for income and job security, and gives people a sense of control over life circumstances - key factors that influence health.

10. Employment and Working Conditions Unemployment is associated with poorer health. People who have more control over their work circumstances and fewer stressful job demands are healthier and often live longer than those involved in more stressful or riskier work and activities.

11. Social Environments Social stability and strong communities can help reduce health risks. Studies have shown a link between low availability of emotional support, low social participation, and mortality.

12. Geography Whether people live in remote, rural communities or urban centres can have an impact on their health.

13. Physical Environments Physical factors in the natural environment (e.g. air and water quality) are key influences on health. Factors in the human-built environment such as housing, workplace safety, community and road design are also important influences.

14. Healthy Child Development The effect of prenatal and early childhood experiences on subsequent health, well- being, coping skills and competence is very powerful. Children born in low-income families are more likely than those born to high-income families to have low birth weights, to eat less nutritious food, and to have more difficulty in school.

15. Health Services Health services, particularly those designed to maintain and promote health, to prevent disease, and to restore health and function, contribute to the population's health.

16. Gender Women are more vulnerable to sexual or physical violence, low income, single parenthood, and health risks such as accidents, STDs, suicide, smoking and physical inactivity. Measures to address gender inequality within and beyond the health system improve population health.

17. Culture Belonging to a particular race or ethnic or cultural group influences population health. The health of members of certain cultural groups can be more vulnerable because of their cultural differences and the risks to which they are jointly exposed.

18. Dahlgren and Whitehead: layered influences model

19. Diderichsen et al.: social stratification and disease production model

20. I.The mechanisms involved are "those central engines of society that generate and distribute power, wealth and risk", for example the educational system, labour policies, gender norms and political institutions. Social stratification in turn engenders differential exposure to health-damaging conditions II.differential vulnerability III.as well as differential consequences of ill health for more and less advantaged groups, shown as mechanism IV."Social consequences" refers to the impact a certain health event may have on an individual's or a family's socioeconomic circumstances. This model includes a discussion of entry points for policy action,

21. Brunner, Marmot and Wilkinson: multiple influences across the life-course